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International Journal of Clinical Obstetrics and Gynaecology 2017; 1(2): 40-47

ISSN (P): 2522-6614


ISSN (E): 2522-6622
Gynaecology Journal Caesarean in rural environment of Eastern Kasai (R.D.
www.gynaecologyjournal.com
2017; 1(2): 40-47
Congo): Cover of the needs and quality of the services
Received: 10-09-2017
Accepted: 11-10-2017
with Kasansa and Tshilenge
Kabongo AG
Higher Institute of Medical Kabongo AG, Bukasa JC, Banza DB, Kayembe C, Mutombo A,
Techniques of Mbujimayi, DR
Congo
Wembonyama S and Losimba J

Bukasa JC Abstract
Higher Institute of Medical Objective: Analyze the coverage of cesarean needs and quality of services in maternity wards of general
Techniques of Mbujimayi, DR hospitals in rural areas of reference
Congo Methods: it is a multicenter, retrospective transversal type. It involved 434 women who delivered by
cesarean section in maternity wards of general hospitals Tshilenge reference and Kasansa in East Kasai
Banza DB (DRCongo)
Higher Institute of Medical Results: The Caesarean section rate was 21.1% in the overall study population, 17.7% to the reference
Techniques of Mbujimayi, DR Kasansa General Hospital and 28% to the reference Tshilenge General Hospital. The indications for
Congo cesarean section were required in 298 cases (68.7%), prudence in 98 cases (22.6%) and necessary in 38
cases (38%). Coverage of needs cesarean related to expected births was 2.1% overall, 1.5% and 2.8%
Kayembe C
Kasansa, Tshilenge. 76 cases (16.4%) of Caesarean sections have a complication. Infectious complications
University of Kisangani,
were most common, 45 cases (59.2%) and among them, suppuration and dropping sutures accounted for
Department of Public Health, DR
Congo 35.1%, 119 cases (27.4%) of Caesarean sections were of poor quality.
Conclusion: The rural caesarean coverage and quality of services are insufficient. Efforts should be
Mutombo A concentrated on increasing capacity care providers, quality monitoring of pregnancy and services, early
Official University of Mbujimayi, diagnosis of the emergency and referral of patients to the appropriate person in a timely manner for rational
Department of Pediatrics, DR management finally thoroughly analyze the perceptions and experiences of caesarean section in rural areas.
Congo
Keywords: Caesarean, coverage requirements, quality of services, rural
Wembonyama S
University of Lubumbashi,
1. Introduction
Department of Pediatrics and
School of Public Health, DR Congo Since the beginning of time, pregnancy and childbirth have spread to the woman a mortal risk.
The risk that haunts every obstetrician explains the ongoing research to achieve the best
Losimba J conditions for a favorable outcome of pregnancy and childbirth. Cesarean section as obstetric
University of Kisangani, intervention, consisting of the surgical opening of the uterus for the rapid evacuation of the
Department of Public Health, DR
conceptus (fetus) is one of the strategies recommended for this purpose [1].
Congo
Once reserved for major dystocia, cesarean section has become a common procedure. Its
incidence is increasing in recent decades despite the recommendations of the World Health
Organization (WHO) not to exceed 10 to 15% [31]. This frequency varies from one country to
another. Estimated at 10-20% in industrialized countries, it reaches about 30% in the US [2].
In the majority of least developed countries, mainly in sub-Saharan Africa, caesarean section
rates remain well below the threshold "security" of 5% set by WHO. In these countries, the rates
are still much lower in rural areas, sometimes below 1% when they reach 5% in urban areas. In
remote rural sites, performing a Caesarean may be simply impossible [10]. The percentage of
Caesarean sections within a population can measure the level of access and use of this
intervention. It can serve as an indicator for policy makers and governments to assess progress
in maternal and child health and monitor emergency obstetric care and the use of resources [30].
This study aims to analyze the coverage of cesarean needs and quality of services in maternity
wards of general hospitals in rural areas of reference

2. Methods
Correspondence
Kabongo AG This is a multicenter, retrospective, cross-sectional. It involved women who delivered by
Higher Institute of Medical cesarean section in maternity wards of general hospitals Tshilenge reference and Kasansa in East
Techniques of Mbujimayi, DR Kasai (DR Congo). The study's data were for 434 cesareans performed for 2 years or from
Congo 01/01/2015 to 31/12/2016 in so-called maternity. Included are all the women who have been

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International Journal of Clinical Obstetrics and Gynaecology

Operated in these maternity hospitals while those having been Indications of need are performed for diseases generally
made in other structures and sent to the treatment were excluded. accessible preventive treatment, but in the absence of
Data for this study were collected in the records (of operating supervision or care during pregnancy and childbirth, may
and delivery rooms), plugs and partopgrammes parturients. have an unfavorable change leading to a surgical procedure
Analysis of obstetric records and logs has identified thirty often performed in emergency maternal rescue (dynamic
indications for cesarean section. To facilitate their study, dystocia, hypertensive disease, another twin pregnancy
classifying cesarean indications approaching that of Maillet [7] maternal disease).
and BOISSELIER [8] Sheikh T et al. [8] and already used in Abusive directions concern all indications caesarean by
several studies, including those of Senegal and Burkina Faso [6 excessive and avoidable: dynamic dystocia not treated
5]
, has been selected as part of this study. This classification medically, without limit basin test of correct work, fetal
involves the concept of mandatory information, prudence and distress based on the sole criterion presence of stained
necessity. Apart from this classification, we also distinguished amniotic fluid, an isolated bradycardia, tachycardia isolated
abusive indications for caesarean sections. etc.
Compulsory particulars relate to situations in which Data entry and data analysis were done using Excel 2007
delivery can not be achieved except by the high way (fetal- software, and analysis performed through the software Epi info
pelvic disproportion, placenta previa, abnormal presentation and SPSS Version 7 13.
(except seat), obstructed labor, pre-rupture and uterine Frequencies and averages of different variables were calculated.
rupture). In these cases, the lack of support by Caesarean Proportions were compared using chi-square tests of Pearson
section leads to death or very serious maternal effects and Yates. The averages, in turn, were compared using Student's
The caution signs correspond to circumstances for which t test. A difference was statistically significant for p value <0.05.
intervention is not necessary, but can bring in some For analysis, the good cesarean criteria were those already used
instances better vital or functional prognosis for the mother, in other settings [6] or caesarean section having no complications
but especially to children (cesarean, breech presentation, (morbidity or mortality) for the mother, child alive.
fetal distress, child "precious "cord prolapse, circular cord,
premature rupture of membranes). 3. Results

Table 1: Frequency of caesarean.


Kasansa Tshilenge Total p-value
Mode of delivery
Effective % Effective % Effective %
vaginally 1142 82.3 486 72 1628 78.9
0.0000 *
caesarean 245 17.7 189 28 434 21.1
TOTAL 1387 100 675 100 2062 100
*= Significantly different from 5%

In this table, we see that in 2062 deliveries were recorded in the of caesarean sections is significantly different in the two
two maternity hospitals, 434 of these deliveries were caesarean structures (17.7% against 28%; p=0.0000).
sections or 21.1% overall structures. The difference in frequency

Table 2: Socio-demographic and obstetric characteristics.


Kasansa (n = 245) Tshilenge Total p-value
Effective % Effective % Effective %
Age n = 245 n = 189 n = 434
<18 17 6.9 16 8.5 33 7.6 0,350
18- 35 years 183 74.7 121 64 304 70 0,016 *
> 35 years 45 18.4 52 27.5 97 22.4 0,023 *
Average and standard deviation 28.1 6.7; 28.9 7.3; t = 0.223 0.223
Parity n = 245 n = 189
primiparae 47 19.2 46 24.3 93 21.4 0.194
Paucipares 34 13.9 23 12.2 57 13.1 0.601
multiparous 85 34.7 62 32.8 147 33.9 0.680
great multiparas 79 32.2 58 30.7 137 31.6 0.729
Mean and standard deviation 4.4 3.2 4.1 3 t = 0, 34 0.340
Gestational age (n = 324) n = 175 n = 149
<37 52 29.7 42 28.2 94 29 0.914
37- 42 102 58.3 84 56.4 186 57.4 0.729
> 42 21 12 23 15.4 44 13.6 0.368
Mean and standard deviation 38.8 3.7 39.5 3.3 t = 0.08 0.088
History of caesarean sections n = 245 n = 189
Once 31 12.7 20 10.6 51 11.8 0.506
Two times 6 2.4 3 1.6 9 2 0.905
Thrice 2 0.8 2 1.1 4 0.9 0.806
Total 39 15.9 25 13.2 64 14.7 0.539
*= Significantly different from 5%

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International Journal of Clinical Obstetrics and Gynaecology

The results of this table show that 70% of patients had the age was not significant (4.43 and 4.13 t = 0.34; p= 0.334)
between 18 and 34 years overall. Significant differences were The mean gestational age was 38.83.7 weeks of amenorrhea
observed Kasansa and Tshilenge for patients aged 18 to 35 years (SA) to 39.5 Kasansa3.3 Tshilenge SA, 29% of caesarean
(74.7% against 64%; p = 0.016) and those over 35 years (18.4% sections were concerned older pregnancies of less than 37 weeks
against 27.5%; p = 0.023). The average age was 28.1, and 13.6% for those over 42 SA. The gestational age difference
respectively6.7 years and 28.97.3 years. The difference was was significant (p = 0.088). Caesarean sections performed on the
not significant (t = 0.223; p=0.223). scarred uterus was 14.7% overall. The prevalence of iterative
Multiparous and high parity showed 33.9% and 31.6% of the caesarean was no different to Kasansa and Tshilenge (15.7%
workforce respectively. The mean difference in the two hospitals against 13.2%; p=0.539).

Table 3: Using services.


Kasansa (n = 245) Tshilenge Total p
Fashion intake Effective n =245 % Effectiven = 189 % Effective n = 434 %
Direct 170 69.4 97 51.3 267 61.5 0.000
Reference 2 0.8 2 1.1 4 0.9 .8063
Emergency Evacuation 73 29.8 90 47.6 163 37.6 0, 000
EIC n = 199 n = 106 n = 305
Any 121 60.8 36 34 157 51.5 0.000
1- 2 9 45.2 2 1.9 11 3.6 0.393
3 69 34.7 68 64.1 137 44.9 0,007
response time n = 245 n = 189 n = 434
<60 minutes 161 65.7 87 46 248 57.1 0.000
60 minutes 84 34.3 102 54 186 42.9
Mean and standard deviation 92.1154.5 142 177.7 t = -3.17 0.001**
*Significant difference = 5% with test X
** = significant difference with 5% t student

Analysis of the results of this table reveals that 61.5% had come sessions with a significant difference between the two structures
directly from their homes across followed by those evacuated (34.7% against 64.1%; p=0.007), 3.6% have been 1 to 2 times
urgently with 163 cases (37.6%). The significant difference was the CPN. 57.1% of the parturient were made within 60 minutes
observed Kasansa and Tshilenge for direct admission (69.4% after the indication and 42.9% after 60 minutes, the average time
against 51.3%; p= 0.0007) and the evacuated (29.8% against between the indication and the start of the operation was
47.6%; p= 0.0001). 92.1154.5 nm, with extremes of 11 minutes and 976 minutes
More than half of women (51.5%) had not followed the EIC and and 142 Kasansa177.7 Tshilenge min (range 11 to 1050
that much more than Kasansa Tshilenge (60.8% against 34%, p= minutes); the very significant difference (p= 0.0016)
0.0000). Overall 44.9% were performed plus or minus 3 CPN

Table 4: Main indications of cesarean section.


Indications Kasansa (n = 245) Tshilenge (n = 189) Total n = 434 p-
Effective % Effective % Effective %
1. mandatory 146 59.6 152 80.4 297 68.7 0.000 *
Rupture / pre uterine rupture 9 3.7 16 8.5 25 5.7
placenta previa 27 11 48 25.4 75 17.3
retro-placental hematoma 23 9.4 6 3.2 29 6.7
malpresentations 44 18 53 28 97 22.4
Pelvic disproportion foeto 36 14.7 28 14.8 64 14.7
contracted pelvis 7 2.9 1 0.5 8 1.8
2. Caution 73 29.8 25 13.2 98 22.6 0.000 *
acute fetal distress 30 12.2 8 4.2 38 8.8
uterine scar 17 6.9 2 1.1 19 4.4
Breech presentation 19 7.8 5 2.6 24 5.5
Prolapsed cord 5 2.1 10 5.3 15 3.4
Circular Cord 2 0.8 0 0 2 0.5
3. Need 26 10.6 12 6.4 38 8.8 0.110
dynamic dystocia 10 4.1 8 4.2 18 4.1
Eclampsia 4 1.6 3 1.6 7 1.6
premature rupture of membranes 3 1.2 0 0 3 0.7
multiple pregnancy 3 1.2 0 0 3 0.7
Other maternal diseases 3 1.2 0 0 3 0.7
prolonged labor 3 1.3 1 0.5 4 0.9
* = Significant difference tests with 5% of X

Compulsory particulars caesarean presented 298 cases (68.7%), in both hospitals for the mandatory information (59.6% against
followed by caution signs with 98 cases (22.8%) and the need 80.4%, p = 0.0000) and the need for information (29.8% against
for information with 38 cases (8.8%) with significant differences 13.2%, p = 0.0000)

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International Journal of Clinical Obstetrics and Gynaecology

Table 5: Coverage of needs caesareans.


Kasansa Tshilenge Total p
Population 216063 310669 526732
expected births 8643 12427 21069
expected caesareans (5% of births) 432 621 1053
caesarean sections 245 189 434
VBAC / expected births 2.8% 1.5% 2.1% 0.0000 *
Caesareans performed / expected caesareans 56.7% 30% 41.2%
*Significant difference = 5% with chi-square test

This table shows that the rate of cesarean section in relation to and 2.1% overall. The coverage of needs is much lower than
the expected births was 2.8% to 1.5% and Kasansa Tshilenge Tshilenge Kasansa (2.8% against 1.5%, p = 0.0000)

Table 6: Complications early post-operative.


Complication Kasansa Tshilenge Total p-value
Effective n = 245 % Effective n = 189 % Effective %
infectious complications 12 4.9 32 16.9 44 59.5 0.000 *
Suppuration of the wall / Coast inverse sutures 6 2.4 21 11.1 27 35.5 0.000
Septicemia 3 1.2 2 1.1 5 6.8 0.983
Uro genital infection 3 1.2 6 3.1 9 11.8 0.282
Peritonitis 0 0 2 1.1 2 2.6 0.368
Endometritis 0 0 1 0.5 1 1.3 0.896
Vesico vaginal trauma 0 0 1 0.5 1 1.3 0.689
Hemorrhage 10 4.1 14 6.9 24 30.3 0.127
Heart problem / MV 3 1.2 3 1.6 6 7.9 0.743
Total 25 10.2 49 25.9 74 17.1 0.000*
*Significant difference = 5% with chi-square test

The prevalence of early maternal complications observed were 0.0000). Hemorrhagic complications (28.9%) were the second
74 cases out of 434 (17.1%) in the entire study population, 10% most recorded complications in cesarean section women.
(25 cases out of 245) to the HGR Kasansa and 27% the HGR However, the difference for these bleeding complications were
Tshilenge (51 cases out of 189) with significant difference (p = not significant in both structures (6.9% against 3.7%, p =
0.0000). Infectious complications were the most observed with a 0.1279) Suppuration and dropping sutures was the most
prevalence of 59.2% in the whole sample and a significantly common infectious complication (35, 5%) with very significant
higher prevalence among women in Tshilenge caesarean difference between the two structures (11.1% against 2.4%; p =
compared to those carried in Kasansa (16.9% against 4 , 9% P = 0.0002).

Table 7: Early postoperative complications according to the classes of information.


Complication Kasansa Tshilenge Total p-value
Effective n = 245 % Effective n = 189 % Effective %
mandatory 17 6.9 41 21.7 58 78.4 0.0000 *
Infectious complications 7 2.9 25 13.2 32 42.7 0.0000 *
Vesico vaginal trauma 0 0 1 0.5 1 1.3 .8963
Hemorrhage 9 3.7 12 6.3 21 28 .1554
Cardiac problem 1 0.4 3 1.6 4 5.3 .3787
Caution 4 1.6 6 3.7 11 14.7
Infectious complications 3 1.2 6 3.2 9 12 0.1575
Cardiac problem 1 0.4 0 0 1 1.3 .8963
Need 3 1.2 2 1.1 5 6.7
Infectious complications 2 0.8 2 1.1 4 5.3 .8063
Vesico vaginal trauma 0 0 0 0 0 0
Hemorrhage 1 0.4 0 0 1 1.3 .8963
Heart problem / MV 0 0 0 0 0 0
Total 25 10.2 49 25.9 74 17.1
*Significant difference = 5% with chi-square test

Table 7 shows that the prevalence of complications in the indications 42.7% overall with a significant difference in both
compulsory indications represented 78.7% followed by those of surgical facilities (2.9% against 13.2%; p = 0.0000); 12% in the
prudence (14.7%) and the need for indications (6.7%). Infectious caution indications and 5.3% in the indications of need with no
complications represented successively in the compulsory significant difference in the two structures.

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International Journal of Clinical Obstetrics and Gynaecology

Table 8: Early complications of cesarean section in accordance with the intake modes.
Fashion intake Kasansa Tshilenge Total p-value
Effectiv (n = 245) % Employes (n = 189) % Effective %
Direct 17 6.9 23 12: 2 41 9.5 0.0419 *
Reference 0 0 1 0.5 1 0.2 0.0980
Emergency Evacuation 8 3.3 25 13.2 34 7.8 0.0000 *
TOTAL 25 10.2 49 25.9 76 17.5
*Significant difference = 5% with chi-square test

The results of this table show that the prevalence of cesarean study population. Prevalence was very insignificant in both
complications was 9.5% in patients who had come directly from structures to those coming directly from home (6.9% against
their homes followed those evacuated urgently with 7.8% 12.7%; p = 0.0419) and very significant for emergency
followed by those evacuated urgently with 7.8% of the entire evacuated (3.3% against 13.8%; p = 0.0000)

Table 9: Prognosis maternal indications as classes.


Class Kasansa (n = 245) Tshilenge (n = 189) Total p-value
Effective % Effective % Effective %
mandatory 6 85.7 4 100 10 90.9 0.925
Caution 1 14.3 0 0 1 9.1 0.896
Need 0 0 0 0 0 0 0.894
TOTAL 7 63.6 4 36.4 11 100 0.863

The results of this table show that of 434 cesarean sections, a were recorded among the need for caesarean in both structures.
total of 11 maternal deaths were reported, representing a 2.5% No significant difference was recorded among all classes of
lethality, Mandatory cesarean represented 90.9% of caution indications.
followed fatality of caesarean sections (9.1%) and no deaths

Table 9: fetal prognosis according to the classes of information.


CLASS Kasansa (n = 245) Tshilenge (n = 189) Total p-value
Effective % Effective % Effective %
Mandatory 22 73.3 34 91.9 56 83.5 0.0105 *
Caution 5 16.7 2 5.4 7 10.5 .6734
Need 3 10 1 2.7 4 6 .8063
TOTAL 30 44.8 37 55.2 67 100 0.0360 *
*Significant difference = 5% with chi-square test

Resulting in this table shows that perinatal mortality was difference was not significant in the structures for both the
amounted to 15.4%. Required caesareans were more deaths with mandatory information (73.3% against 91.9% p = 0.0105) for all
83.6% followed by caution cesarean (10.5%). Child fatality indications 44.8% against 55.2% p = 0.0360)

Table 10: Quality of caesareans.


Quality Effective %
Good 316 72.8
Bad 118 27.2
Total 434 100

In applying the quality criteria caesarean section, the results of both structures.
this table show that 27.2% of cesarean sections were poor in

Table 11: Quality of caesareans according to the classes of indications of cesarean section and maternal intake patterns.
Class Kasansa (n =245) Tshilenge (n = 189) Total p-value
BQ MQ BQ MQ
Eff % Eff % Eff % Eff %
Indications
Mandatory 112 76.7 34 23.3 93 61.2 59 38.8 298 * 0.007
Caution 61 83.6 12 16.4 19 76 6 24 98 0.497
Need 22 84.6 4 15.4 10 83.3 2 16.7 38 0.427
Fashion adm
Direct 145 85.3 25 14.7 64 66 33 34 267 0.936
Reference 1 50 1 50 1 50 1 50 4
Emergency Evacuation 49 67.1 24 32.9 57 63.3 33 36.7 163 0.893
Total 195 44.9 50 11.5 122 28.1 67 15.4 434 0,000 *
*Significant difference = 5% with chi-square test; BQ = good, MQ = Poor

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International Journal of Clinical Obstetrics and Gynaecology

Reading this table shows that overall the quality of cesarean was 37.6% were evacuated in emergency overall with very
worse than in Tshilenge Kasansa (11.5% against 15.4%, p = significant difference between the two surgical facilities (p =
0.000) Also in the compulsory indications of cesarean section 0.05). Unlike some African authors [5, 6.11], all these women
(24% against 16.4%; p = 0.007). While no significant difference evacuees were from the health center. It noted that only 0.9% of
was observed in relation admission modes. women treated had been referred (from NPC) to a surgical
center before the start of work.
4. Discussion
4.1 Epidemiology 4.2.1.2 Monitoring of pregnancy
This study was initiated to identify the epidemiological situation Note that 44.9% of operated patients had a minimum of 3 EIC
and the coverage of cesarean needs in rural health areas and required and made two had received no CPN (50.5%). More
Tshilenge Kasansa. The main results show. likely to Kasansa that Tshilenge (p = 0.05). While it noted more
Between 1 January 2015 and 31 December 2016, 2062 women women who received roughly 3 sessions of NPC to Tshilenge
gave birth in the reference general hospitals and Kasansa that Kasansa (p = 0.05). This low coverage of the EIC explain
Tshilenge. Among them 434 (21.1%) had a caesarean. the low reference rate of women in labor (0.9) for all structures
Significant differences were observed between Tshilenge and including the indications for cesarean were predictable, but also
Kasansa (p<0.05). Compared to the literature, this rate is lower the difficult acceptance of referral of women to a sharp surgical
than those reported in hospitals in Guinea 36% [11] but center by fear of caesarean section on one hand and on the other,
corroborates the observed rates CHU Yalgado Ouedragogo [6] by the social repercussions this operation into poverty. Hence
which was 21.6% with a slightly higher sample ours 473 and the woman comes to the hospital late after several attempts,
university clinics and the general hospital Kalemie reference sometimes dangerous (to the health center or at home).
was 24.1% with a sample of 488 and Panzi hospital (23.5%) by Our reference rate was much lower than in Senegal which was
Cikwanine B. [32] and it remains slightly higher than that 28% in the series of CISSE [5], that of Ouagadougou which was
recorded in Yaounde by Foumane P. et al., (19.7%) [33]. 13.6% in the C series of Ouedraogo et al. [6] and roughly 50%
However it was double that found on the city of Lubumbashi is times what was recorded at Panzi (45.1%) [32] we agree with
10.65%. [23] Unlike our study, most of these results (Excepted CISSE [5] and Ouedraoga C et al. [6] these results lead us to
the Panzi) come from studies in urban areas by all teaching question the current quality NPC in the fight against maternal
hospitals for some. mortality and morbidity.
The average age of women caesarean was 28,42ans with a
standard deviation of 6.96 years (Extreme 15 and 47 years). This 4.2.2 Indications for cesarean
average was not significantly different in the two surgical The main indications were respectively represented by abnormal
facilities (p>0.05). The influence of age on caesarean section presentations (27.9%), placenta previa (17.3%), the
was also reported by several authors [12, 23]. All these studies foetopelvienne disproportion (16.6%), fetal distress (8.8%).
have shown that mothers under 15 years and 35 years and older These indications were valued differently by several authors,
have a higher risk of undergoing caesarean section. most of which noted the high frequency of obstructed labor. So:
Primiparous and high parity were the most affected by caesarean In Senegal, Cisse [5] noted 30.4% of fetal-pelvic disproportion,
section 34.8% and 31.6%. These results are higher compared to fetal distress 18.2%, 6.5% and 3.7% anomalous presentations for
those found by Diallo FB et al. [26] who found that extreme placenta previa
parities were most affected by caesarean section with 22.46% in In Ouagadougou Ouedraogo C et al. [6] on the other hand,
primiparous and 21% among high parity. The average rate was observed 25.1% feto pelvic disproportion, 15.2% of acute fetal
4.312.83 extreme 0 and 15) with no significant difference distress, 10% and 4% malpresentation placenta previa.
(p>0.05). This average is much higher than that found by In Guinea, Keita N. et al. [11] noted 16.3% of fetal distress, 9.1%
Kinekinda et al. 2.62.5 to Lubumbashi [23]. This rate is foeto pelvic disproportion, 7.9% for abnormal presentations and
significantly higher than that observed in Kalemie (14.1%) [12]. 4% of placenta previa.
In our series gestational age ranged between 22 and 47 SA These indications are placed on basis of clinical examination,
around an average of 39 4 SA, but the difference was electronic monitoring is not still relevant in our communities.
significant (p> 0.05), 29% of caesarean section have been on In our series on the classification by groups of indications
pregnancy age less than 37 weeks. showed that the mandatory information were more common than
Indeed, previous Caesarean section remains one of the main caution indications (68.7% vs 22.6%; p<0.05) and safety
causes of cesarean sections in many countries [24, 25]. In our series indications outnumbered those in need (22.6% vs 8.8%; p<0.05).
iterative caesarean represented 14.8%. These rates are double These results corroborate those of Kabandilwa SE et al., [12]
those reported by most authors: 6.6% Kadony Mumba N et al. those recorded in Guinea where caution indications (48.97%)
[28]
A Lokossou. et al. [16]; Dembele et al., Thaore Y et al. [17]. were double the mandatory information (22.80%) [11] and
However it is close to that found by Kinekinda et al. (11%). [23] Senegal is 43, 8% for the mandatory information, 30.8% for
The risk of a major complication during a trial of labor explain precautionary indications and 25.4% for the need for
this phenomenon. There is indeed a risk of about 1% of uterine information [5]. Our rate of iterative caesarean section (cesarean)
rupture during an attempted vaginal birth after a [15] C-section. is much lower than those observed in Guinea [11] and
Ouagadougou [6], in Kalemie (DRC) [12] Abusive indications
4.2 Service use and indications of caesarean sections have not been directly observed. This absence does not reflect
4.2.1 Service utilization their nonexistence. Whatever it was, it is believed that around
4.2.1.1 Operating maternal intake 6% of cesarean were abusive by referring to the threshold
In our series, 61.5% of caesarean women had come of accepted by WHO (15% maximum). This frequency is
themselves. It is Kasansa that this mode of admission was more significantly lower vis--vis those reported by Ouegraogo C and
noticed (p<0.05). The difference was also significant about the K Abandilwa [6, 12].
emergency evacuation in two hospitals (p<0.05). However

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International Journal of Clinical Obstetrics and Gynaecology

4.3 Coverage of needs improve. Thus, the perinatal mortality rate was significantly
434 caesarean sections correspond to a rate of 2.1% of all births higher in the compulsory indications (p <0.05). These data
in relation to expected, or less than minimum threshold set by reflect the seriousness of the maternal table with its negative
WHO to 5%. Coverage of caesarean needs is lower than in impact on the fetus.
Tshilenge Kasansa (p<0.05). This coverage, while remaining Achieving cesarean should be seen as an end in itself, but a
below the WHO threshold, are much higher than those found in means among others to improve the health of mother and child.
Senegal by CISSE et al. [5] (0.6% over all, 1.3% and 0.1% in It is then important to look at all factors that can influence the
Dakar Kaolack Fatick.). The. qu'on explanation can give this success of cesarean section, that is to say, the mother and child
low coverage of caesarean requirements would be the fact that in survive in the best possible conditions and without sequelae.
addition to geographical and financial access difficulties, In applying the quality criteria at the start, almost a third of
feelings of humiliation and failure experienced by women, cesarean sections (27.2%) was poor. With very significant
cesarean section is often seen as a major procedure, disabling, differences in Tshilenge both overall (p< 0.05) for the
associated with fear to see her belly '' re-open '' at the slightest mandatory information (eg<0.05). No significant difference to
effort which goes against the role played by women in rural the poor quality of cesarean section was observed depending on
societies of black Africa where they assume the painstaking maternal intake patterns in the two structures. This is explained
work involves physical integrity. Hence, the same cesarean for by the fact that most C-sections performed for compulsory
referrals to the ANC, are performed in emergency because the indications, are mostly in emergency without good prior
woman occurs only when all remedies (Attempts to deliver at preparation.
home, consulting other structures than had referred, prayer, As for the conditions of implementation of the intervention, it
traditional healer.) are exhausted. Hence it is necessary to try to was observed that most C-sections performed in emergency
understand the perceptions of women on this vital intervention should have been programmed because of the existence of
to save the mother and child if the way is not possible. factors indicating the counter vaginally. Prospective analyzes
African media revealed several obstacles in achieving caesarean
[5, 6]
4.4 Quality of services .
4.4.1 Postoperative complications
Among our patients operated, 75 of them or 17.8% had at least 5. Conclusion
one complication with 63.4% of septic complications. In our Epidemiological surveillance of surgical obsttrico- coverage is
series the rate of septic infections is lower than in other African very little studied in Black Africa. This study allowed to
countries: 93.3% by Ouedraogo et al. [6] in Ouagadougou, 55% understand that obstetric emergencies are a real public health
in Senegal by CISSE C [5] and it is similar to that observed problem in rural areas because of the very poor prognosis they
Yaounde (16.95%) by Ngowa JDK et al. [29]. impose on the mother and child pair.
The are mandatory information presented more complications of The results from our study that the coverage of cesarean needs
cesarean section than other classes (78.7%) and a very remains lower (2.1%) the minimum threshold required by the
significant difference between Kasansa and Tshilenge (p<0.05). WHO (5%) and about one third (27.2%) and very significantly
Infectious complications occupied the head in all classes of the quality service was worse than in Tshilenge Kasansa this in
indications and a significantly different prevalence in the two all directions for the mandatory information (eg< 0.05).
structures among the mandatory information (eg<0.05). These results challenge a strengthening aseptic perioperative
The higher prevalence of complications among patients come measures in surgery to reduce infectious complications.
directly to home and those evacuated by the health centers could Efforts should be concentrated on increasing capacity care
be explained by the fact that these women would drag either at providers, quality monitoring of the pregnancy, early diagnosis
home or in the structure which referred to reaching hospital of the emergency and referral of patients to the appropriate
often late for some reason (failed attempt to deliver at home, person in a timely manner to a decision in rational load finally
lack of transportation, delay in evacuation decision by health thoroughly analyze the perceptions and experiences of caesarean
centers. ..). Yet it follows from the literature as C-sections made section in rural areas. Everyone is concerned, starting with the
emergency have 10 times more complications (20-30%) that state, providers, pregnant and people.
elective caesarean sections (2 to 3%) [34, 35, 36, 29].
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